Vertical Soft Tissue Research Articles

Double-Opposing Z-plasty for Correction of Midline Cervical Web

Midline cervical web is a rare congenital anomaly that may be associated with a spectrum of midline developmental anomalies of the neck, lower face, and mandible. The clinical hallmark is a fibrous band typically extending from the symphysis of the mandible to the suprasternal notch. Various techniques have been used for surgical correction and generally have involved excision either with a straight-line closure or the incorporation of a Z-plasty. The Z-plasty method usually has included only skin and subcutaneous fat, but the development and transposition of composite skin-platysma flaps has been used. The authors describe the correction of a midline cervical web designed with double-opposing Z-plasties of skin and subcutaneous fat and platysma muscle mobilized and transposed separately. This technique provides two primary benefits: creation of a well-defined cervicomental angle, and correction of the vertical soft tissue deficiency in the anterior neck.

The effect of precise reattachment of the mentalis muscle on the soft tissue response to genioplasty

Purpose: This study compares vertical and horizontal profile changes of the lower lip and chin after genioplasty with or without precise reattachment of the mentalis muscle. Patients and Methods: Ten patients in whom the mentalis muscle was isolated, identified, marked, and precisely reapproximated comprised the study group. Eleven patients treated without precise reattachment of the mentalis comprised the control group. Preoperative (3 to 6 days before the surgery) and postoperative (6 months after surgery) lateral cephalograms were analyzed to assess the horizontal and vertical soft tissue changes of the lower lip and chin area. Results: All the significant changes in the present study were noted in the vertical parameters. In most of the study group, the length of the lower lip was either maintained or increased. In the control group, the lower lip length was either preserved or decreased. The mean vertical difference between the 2 groups was nearly 6 mm. Consequently, the study group displayed the same or less of the lower incisors postsurgery compared with the original presurgery exposure in the rest position. The opposite was true for the control group, in which the exposure of the lower incisor crowns at rest increased. Similar changes were noticed in the distance from the vermilion to the reference plane. The vertical position of the soft tissue supramentale remained unchanged in the study group, whereas in the control group the soft tissue supramentale was located in an inferior position (mean = 2.14 mm). The clinical expression of this phenomena is chin ptosis. Conclusions: Precise reattachment of the mentalis muscle during an intraoral surgical approach produces a superior result. © 2001 American Association of Oral and Maxillofacial Surgeons

Soft tissue changes of the upper lip associated with maxillary advancement in obstructive sleep apnea patients

Purpose: This retrospective study evaluated the horizontal and vertical soft tissue changes that occur with maxillary advancement surgery with a Le Fort I osteotomy with concomitant anatomic reorientation of the nasolabial musculature. Subjects and Methods: Fifteen OSA patients who underwent maxillary advancement with a Le Fort I osteotomy without adjunctive nasal soft tissue procedures were studied after a minimum of 8 months of follow-up. The V-Y technique was used to close the maxillary vestibular incision. Only cases with minimal vertical movement (< 3.5 mm) in which no orthodontics were used were included. The average maxillary advancement was 8.0 ± 2.5 mm, measured at the upper incisor (UPI) and the average vertical movement was 0.7 ± 1.8 mm. The horizontal and vertical soft tissue change in subnasale (SN), labrale superiorus (LS), superior stomion (SS), nasal tip (NT), nasolabial angle (NLA), and lip length were measured in each patient and correlated with hard tissue measurements at anterior nasal spine (ANS) and UPI. The effect of lip thickness on these soft tissue changes also was evaluated. Results: Using mean data, the horizontal soft-to-hard-tissue ratio for LS to UPI was 0.80:1, with a concomitant vertical (superior) soft tissue change to hard tissue advancement of 0.16:1. Lip length did not change significantly. All patients except 1 showed a slight decrease in nasolabial angle. The average decrease was 5° (range, −10° to +7°). There was no statistically significant correlation between the degree of change in NLA and the amount of maxillary advancement. Conclusion: This study showed that advancement of the maxilla when controlling vertical movement resulted in the a hard-to-soft-tissue ratio of LS:UPI of 0.80:1. NLA did not change significantly. © 2001 American Association of Oral and Maxillofacial Surgeons

Soft and hard tissue changes in Class III patients treated by bimaxillary surgery.

A cephalometric study of 17 non-growing dentate Class III subjects treated by bimaxillary surgery was undertaken to assess the results of treatment and to evaluate the correlation between soft and hard tissue change. It was concluded that: (i) the orthognathic profiles achieved were brought about by a combination of maxillary advancement and mandibular setback; (ii) a strong correlation in the horizontal direction occurred between all the selected landmarks of the lower lip and chin, but only between superior labial sulcus and point A in the upper lip; highest intra-group correlations were seen between corresponding soft and hard tissue points; the ratios of soft tissue to corresponding hard tissue movements in lower lip and chin approached 1:1; (iii) in the vertical direction, a strong correlation occurred in the lower lip and chin; highest intra-group correlations were not necessarily with corresponding landmarks; and (iv) vertical movement of landmarks on the nasal base and upper lip generally showed poor or weak correlation with corresponding soft tissue points. The most reliable hard tissue predictors of horizontal and vertical soft tissue change are tabulated for application in bimaxillary surgery for the Class III patient.

Soft Tissue Change After Single Jaw(mandible) Surgery in Skeletal Class III Malocclusion

The purpose of this study was to evaluate the amount and interrelationship of the soft and hard tissue change after mandibular setback surgery in skeletal Class III malocclusion. The sample consisted of 25 adult patient (12 male and 13 female) who had severe anteropostrior skeletal discepancy. These patient had received presurgical orthodontic treatment and surgical treatment which is bilateral sagittal split ramus osteotomy. The presurgical and postsurgical lateral cephalograms were evaluated. The computerized statistical analysis was carried out with SPSS/PC program. The result were as follows: 1. After mandibular bilateral sagittal split ramus osteotomy, lower facial soft. tissue horizontal posterior changes were high significance value. but vertical soft tissue changes were low significance value. 2. After mandibular bilateral sagittal split ramus osteotomy, relative upper lip protrusion increased(p

Skeletal change at surgery as a predictor of long-term soft tissue profile change after mandibular advancement

Purpose: This study examined the time course of hard and soft tissue changes after mandibular advancement surgery and the association between skeletal changes as a result of surgery and subsequent soft tissue changes. Patients and Materials: Subjects were enrolled in a randomized clinical trial of rigid versus wire fixation after sagittal split ramus osteotomy, with cephalometric data obtained before orthodontics, immediately before surgery and at 8 weeks, 6 months, 1 year, and 2 years postsurgery. This early report describes changes in 20 Caucasian female subjects who had completed all phases of the study; these were not segregated by fixation method. Cephalometric changes were referenced to a cranial base coordinate system. Differences in soft and hard tissue changes among time intervals were examined using analysis of variance; the associations between immediate surgical change in chin landmarks and subsequent short- and long-term soft and hard tissue changes were examined using linear regression analysis. Results: Soft and hard tissue mandibular structures were positioned anteriorly and inferiorly during surgery; the horizontal and vertical hard tissue mandibular changes were stable for 2 years after surgery ( P > .30), as were the vertical soft tissue changes ( P > .08). There was horizontal relapse of the lower lip and the inferior sulcus ( P < .03) by 8 weeks; no horizontal relapse was detected in soft tissue chin points for up to 2 years after surgery. The time course of changes in osseous pogonion was more strongly predicted by the amount of surgical osseous chin change than were changes in soft tissue chin projection. Conclusions: Prediction of changes in soft tissue chin projection after mandibular advancement surgery is less certain as time from surgery increases and less certain than the prediction of changes in bony chin projection.

Long-term stability and prediction of soft tissue changes after LeFort I surgery

Many evaluations of soft tissue changes after orthognathic surgery have been undertaken, and many correlations of soft tissue to hard tissue movements have been established. These studies have not, however, specifically discussed the long-term stability or characteristics of the soft tissue changes. The objectives of this study were (1) to determine the long term stability of soft tissue changes 5 years after LeFort I osteotomy, (2) to determine reliable correlations, if any, of soft tissue changes to bony movements effected in surgery, and (3) to determine the predictability of soft tissue changes as an aid to orthodontic treatment planning. Cephalometric data from 25 patients who were treated with LeFort I osteotomy with or without a concurrent mandibular procedure were analyzed retrospectively. Cases were selected from the patient records of the Department of Oral Surgery of the Vrije Universiteit in Amsterdam, the Netherlands. These patients were followed up at four time points, the last being a mean of 6.1 years after surgery. Analysis of stability data revealed that most horizontal and vertical soft tissue change after LeFort I surgery occurred in the first year after surgery. Significant (> 10%) change continued to occur for subnasale, labrale inferius, upper lip protrusion, lower lip protrusion, and soft tissue convexity during the subsequent 5 years. Hard tissue to soft tissue correlations were calculated and ratios of soft tissue to hard tissue movement were determined for appropriate hard and soft tissue landmarks at four time intervals. Reliable correlations of hard tissue change at surgery to 5-year soft tissue change could be made for 10 variables, which was considerably less frequently than for 1-year soft tissue change. The relatively low reliability of long-term prediction correlations suggests that soft tissue movements may be more independent of hard tissue over time. One-year prediction values were similar to 5-year values and thus could be used for prediction purposes in orthodontic treatment planning. Most short-term hard to soft tissue correlations found in the present study were in the range of those established by previous authors. Long-term hard tissue to soft tissue correlations gave higher ratios of soft tissue movement secondary to maxillary surgery, approaching ratios of 1.0:1.0 for some variables. This finding, as well as the long-term stability data, suggest that soft tissue settling or equilibrium after surgery may take several years to complete.